# EYECARE MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376599381
- **Authorized official:** LYNN SHORTY RN, CMPE (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (207) 791-8234

## Contact information

- **Practice address:** 53 SEWALL STREET, PORTLAND, ME 04102-2625
- **Practice address phone:** (207) 828-2020
- **Practice address fax:** (207) 773-7034
- **Mailing address:** 53 SEWALL STREET, PORTLAND, ME 04102-2625
- **Mailing address phone:** (207) 828-2020
- **Mailing address fax:** (207) 773-7034

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 36395 | ME | Yes |

## Other

- **Enumeration date:** 05/25/2006
- **Last updated:** 12/17/2021